Papers by Alexander Jurko
Ceskoslovenská pediatrie, 1978
Acta Clinica Belgica, 2018
Introduction: LEOPARD syndrome is a rare genetic disorder characterised by lentigines, electrocar... more Introduction: LEOPARD syndrome is a rare genetic disorder characterised by lentigines, electrocardiographic conduction abnormalities, ocular hypertelorism, pulmonary stenosis, abnormal genitalia, retardation of growth and sensorineural deafness. Clinical manifestations are often mild, which may result in difficult and late diagnosis. Cardiac involvement may have a significant impact on the prognosis, however, appearance of severe abnormalities such as hypertrophic cardiomyopathy usually precedes the occurrence of multiple lentigines and may be asymptomatic. Case presentation: We report two cases of LEOPARD syndrome with hypertrophic cardiomyopathy in a 10-year-old girl and an 18-year-old boy. In both cases, multiple lentigines, ocular hypertelorism and growth retardation were present. The first patient was followed up at the paediatric cardiology clinic due to the risk of progression of septal hypertrophy and pressure gradient across the left ventricular outflow tract, the second patient underwent surgery for a moderate obstruction of the left ventricular outflow tract with uncomplicated post-operative follow-up. Conclusion: In both presented patients, hypertrophic cardiomyopathy was clinically silent and the murmur over the precordium was the sole cardiac abnormality revealed during routine visit. A detailed cardiologic examination should be considered in the patients with suspicion of LEOPARD syndrome since the ventricular hypertrophy is thought to precede the occurrence of lentigines and progress over time.
International Journal of Psychophysiology, 2018
Neuro endocrinology letters, 2019
BACKGROUND Left ventricular non-compaction (LVNC) is a rare form of cardiomyopathy resulting from... more BACKGROUND Left ventricular non-compaction (LVNC) is a rare form of cardiomyopathy resulting from a disorder of endomyocardial morphogenesis associated with significantly increased risk of cardiovascular morbidity and premature mortality. Despite the widespread use of echocardiography, LVNC is commonly overlooked, often due to lack of knowledge about this disorder. METHODS AND RESULTS A complex diagnostic process and follow-up was analysed in 24 patients diagnosed with LVNC between March 2002 and February 2016 (16 boys, 8 girls; age at presentation 9 days - 18 years; follow-up 2-7 years). 17 patients were initially overlooked and followed-up for different diagnoses. After retrospective evaluation by a senior specialist in paediatric cardiology, LVNC was identified in 3 patients initially diagnosed with dilated cardiomyopathy, 11 patients followed-up with various forms of arrhythmias, and 3 patients with congenital heart disease. The diagnosis of LVNC was confirmed using magnetic res...
International Journal of Molecular Sciences, 2020
Neuro endocrinology letters, 2016
OBJECTIVES Prognosis of patients with anomalous origin of the left coronary artery from pulmonary... more OBJECTIVES Prognosis of patients with anomalous origin of the left coronary artery from pulmonary artery has dramatically improved as a result of both, early diagnosis and improvements in surgical techniques. Post surgical complications are rare and most patients show quick improvement of the left ventricular performance after repair with complete functional recovery within one year after surgery. Exercise-induced electrocardiographic changes have been found in patients postoperatively and scars and perfusion deficits of the left ventricle may not be detected by standard echocardiographic evaluation. METHODS Authors present 6 cases of anomalous origin of the left coronary artery from pulmonary artery observed at Martin Univesity Hospital and Pediatric Cardiology Clinic over the last eight-year period. In order to assess the presence of myocardial injury, cardiovascular magnetic resonance imaging with late gadolinium enhancement technique was performed in all 6 cases one year after s...
Physiological Research, 2020
Respiratory sinus arrhythmia (RSA), i.e. heart rate (HR) variations during inspiration and expira... more Respiratory sinus arrhythmia (RSA), i.e. heart rate (HR) variations during inspiration and expiration, is considered as a noninvasive index of cardiac vagal control. Mitral valve prolapse (MVP) could be associated with increased cardiovascular risk; however, the studies are rare particularly at adolescent age. Therefore, we aimed to study cardiac vagal control indexed by RSA in adolescent patients suffering from MVP using short-term heart rate variability (HRV) analysis. We examined 12 adolescents (girls) with MVP (age 15.9±0.5 years) and 12 age and gender matched controls. Resting ECG was continuously recorded during 5 minutes. Evaluated HRV indices were RR interval (ms), rMSSD (ms), pNN50 (%), log HF (ms2), peak HF (Hz) and respiratory rate (breaths/min). RR interval was significantly shortened in MVP group compared to controls (p=0.004). HRV parameters-rMSSD, pNN50 and log HF were significantly lower in MVP compared to controls (p=0.017, p=0.014, p= 0.015 respectively). Our study...
International Journal of Psychophysiology, 2018
Artery Research, 2020
Background: Cardio-ankle vascular index (CAVI) has long been considered a measure of arterial sti... more Background: Cardio-ankle vascular index (CAVI) has long been considered a measure of arterial stiffness independent of short-term changes in blood pressure (BP) [1]. Recently and theoretically, CAVI was found to be partially affected by actual BP, thus, a novel BP-corrected index, CAVI 0 , was proposed to diminish these effects [2,3]. Direct, repeated measures experimental data comparing CAVI's and CAVI 0 's acute blood pressure dependence is lacking. Hence, the aim of this study was to assess the effects of short-term changes of BP on CAVI 0 in comparison with standard CAVI. Methods: 60 healthy adults were examined using vascular screening system VaSera 1500 N (Fukuda Denshi Co., Tokyo, Japan) during four examination periods lasting 5 minutes-baseline, cold pressor test (CPT), recovery period, and isometric handgrip exercise (IHE). CAVI and cardiovascular parameters for calculation of CAVI 0 were measured after baseline, at the peak of pressor response to CPT, after recovery period, and at the peak of pressor response to IHE. CAVI, CAVI 0 , and mean BP were assessed for all periods. Results: CAVI significantly increased during CPT compared to baseline rest (p = 0.008), returned to baseline values during recovery period (p = 0.011 compared to CPT), and significantly increased during IHE compared to recovery period (p = 0.002). No significant changes of CAVI 0 were found. CAVI significantly correlated with changes in mean BP (p = 0.012; multilevel regression); CAVI 0 did not (p = 0.570). Conclusion: In this repeated measures, experimental, acute study, CAVI showed short-term blood pressure dependence, whereas CAVI 0 did not.
International Journal of Molecular Sciences, 2019
Cervical cancer is associated with a causative role of human papillomavirus (HPV), which is a hig... more Cervical cancer is associated with a causative role of human papillomavirus (HPV), which is a highly prevalent infection. Recently, women with a genital HPV infection were found to have increased incidence of cardiovascular diseases (CVD), including severe cardiovascular events such as myocardial infarction and stroke. The pathomechanisms of this relation are not yet fully understood, and may significantly affect the health of a large part of the population. Accelerated atherosclerosis is assumed to play a key role in the pathophysiology of this relationship. To identify high-risk groups of the population, it is necessary to stratify the CVD risk. Current algorithms, as widely used for the estimation of CVD risk, seem to be limited by the individual misclassification of high-risk subjects. However, personalised prediction of cardiovascular events is missing. Regarding HPV-related CVD, identification of novel sensitive biomarkers reflecting early atherosclerotic changes could be of m...
Journal of Hypertension, 2019
s e179 association between the performance in the 6MWT with anthropometric and hemodynamic parame... more s e179 association between the performance in the 6MWT with anthropometric and hemodynamic parameters collected before and after the test in a sample of children attending the 3rd and 4th classes in 4 primary schools in Verona South district. Design and method: The 6MWT was performed in a 36m circuit and the total run distance was recorded. Before and after the end of the test some hemodynamic parameters, such as heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP). Sedentary activity (MET/min wk) was assessed through a validated questionnaire (PAQ-C) Results: Two hundred ninety-four (294) over 309 (95%) children were included in the study (Average age: 8.64 ± 9.0 years; male: 50%). The mean 6MWT distance (6MWT-D) was 548.0 ± 57.0m. The 6MWT-D was lower in overweight or obese (OW&OB; n = 100) children as compared to normal weight (NW; n = 194)) children (mean difference (OW&OB-NW):-18.0 ± 7.0m, p = 0.07). The post 6MWT-Rate Pressure Product (RPP = HR*SBP, mean = 10783.9 ± 2282.4 bpm*mmHg) were signifi cantly higher in the OW&OB group with respect to the NW group (mean difference = 1227.1 ± 272.1bpm*mmHg, p = 9E-6). A better performance in the 6MWT-D was associated to higher RPP values (b = 0.006, SE:0.001, p = 3.2E-5), adjusting for age, sex and height. This association is maintained in the NW group (b = 0.010, SE:0.002, p = 4.2E-7) but not in the OW&OB group (b = 0.004, SE:0.002, p = n.s.). Children classifi ed as highly sedentary in PAQ-C score have higher values of delta RPP respect to the more active group (mean difference (post6MWT-pre6MWT) = 1159.8 ± 434.7 bpm*mmHg, p = 0.02). Conclusions: Obese and overweight children, despite a major hemodynamic challenge, as suggested by a higher RPP in overweight and obese children with respect to normotensive ones, have a worsen performance in the 6MWT. Lifestyle changes should aim not only to weight reduction but also to better body fit.
Journal of Hypertension, 2019
Objective: Arteriovenous fi stula (AVF) is the vascular access of choice in patients with end-sta... more Objective: Arteriovenous fi stula (AVF) is the vascular access of choice in patients with end-stage kidney disease (ESKD) requiring hemodialysis (HD). AVF adds a high fl ow and low resistance circuit into the arterial system. We had previously shown that AVF is associated with a reduction in blood pressure and aortic stiffness, but no signifi cant changes in augmentation index. The aim of the present study was to study the impact of AVF according to reservoir-wave analysis (RWA), a new model of arterial tree that is based on the assumption that measured arterial pressure is composed of volume-related (reservoir pressure, RP) and wave-related components (excess pressure, (XSP). Design and method: In 31 ESRD patients (male 64%, age 58 ± 16 years), RWA was performed using pressure approach at the carotid and radial arteries before and after AVF creation (Time interval, 4.1 ± 1.8 months). Among ESRD patients, 16 were already on HD and 15 were awaiting to start HD. Conclusions: Our phase I study in humans indicate that a dose of 10 mg/kg body weight VAS203 reduces renal perfusion within a physiological range, but has no other acute effects on assessed parameters of micro-and macrocirculation.
Applied Physiology, Nutrition, and Metabolism, 2019
Cardiovascular complications contribute to higher morbidity and mortality in patients with anorex... more Cardiovascular complications contribute to higher morbidity and mortality in patients with anorexia nervosa. We aimed to study biomarkers of cardiovascular risk in anorexic, normal-weight, and obese adolescents with focus on complex cardiovascular autonomic regulation and early arteriosclerotic damage. We examined 20 adolescent girls with anorexia nervosa, 20 obese girls, and 20 healthy normal-weight controls. Collected data: body composition analysis, 5 min recordings of R–R intervals and beat-to-beat blood pressure (BP), and arterial stiffness evaluated using cardio-ankle vascular index (CAVI). Evaluated parameters: beat-to-beat heart rate and BP variability, haemodynamic parameters (total peripheral resistance (TPR) cardiac output), CAVI, and anthropometric indices, including novel body roundness index (BRI). Adolescents with anorexia nervosa had increased CAVI associated with lower arterial constriction indexed by low-frequency band of BP variability compared with normal-weight ...
Journal of Hypertension, 2019
P d) in the light boxes, after which the form automatically determines the appropriate scale coef... more P d) in the light boxes, after which the form automatically determines the appropriate scale coefficients (a and b), determines unscaled CAVIs, and converts those to CAVI 0 s. CAVI, cardio-ankle vascular index; CAVI 0 , cardio-ankle vascular index zero [3]; P ref , reference pressure [3].
Journal of Affective Disorders, 2019
Background: Cardiovagal control is known to be reduced in major depressive disorder (MDD), howeve... more Background: Cardiovagal control is known to be reduced in major depressive disorder (MDD), however, the neurocardiac reflex control to distinct types of stressors is still unclear. We aimed to study parasympathetically mediated cardiac reflex functioning in response to mental and physiological stressors using heart rate variability (HRV) linear and nonlinear analysis in adolescent MDD. Methods: We examined 60 adolescents (40 girls) with MDD (age 14.9 ± 0.3 years) and 60 age and gendermatched controls. ECG was continuously recorded during stress protocol: baseline, Go/NoGo test, recovery, supine position, and orthostasis. Evaluated HRV linear and nonlinear indices: RR interval, pNN50, rMSSD, HF-HRV, Poincaré plot (SD1), symbolic dynamics 2UV%. Cardiovagal reactivity expressed as percentual change (%) was calculated in response to both stressors. Results: In each phase of stress protocol, the MDD group had significantly reduced HRV parameters compared to controls, except for symbolic dynamics index 2UV% in supine position. The reactivity of HRV indices was significantly greater in response to orthostasis in MDD compared to controls. No significant differences were found in response to Go/NoGo test. Limitations: The smoking status and the menstrual cycle phase potentially affecting the HRV parameters were not monitored. Future research is needed to expand a sample size with respect to sex and to study neurocardiac response to other different stressors in MDD. Conclusions: This study revealed reduced resting cardiovagal regulation and greater vagal withdrawal indicating abnormal neurocardiac reflex functioning to physiological stressor (orthostasis) in adolescent MDD patients. Nonlinear HRV analysis was sensitive to detect cardiac-linked regulatory differences in adolescent depression.
Progress in Pediatric Cardiology, 2019
Among the rare chromosome abnormalities compatible with life, partial monosomy of chromosome 18 i... more Among the rare chromosome abnormalities compatible with life, partial monosomy of chromosome 18 is a relatively frequent chromosomal aberration. The affected individuals are at relatively increased risk of having congenital cardiac defects with the pulmonary valve anomalies and atrial septal defects being the most common findings. We report a patient with a distal 18q deletion, follow-up from birth to 15 years of age, and a novel finding of distal 18q-associated cardiovascular anomaly-a pulmonary artery sling. Since birth, the patient presented with characteristic phenotype features, respiratory distress, and frequent respiratory infections. Echocardiographic examination revealed atrial septal defect and a suspicion for presence of pulmonary artery sling, which was later confirmed using computed tomography angiocardiography. During the surgery at 18 months of age, patent ductus arteriosus was found and repaired together with repair of atrial septal defect and pulmonary artery sling. Postoperatively, the stridor and respiratory distress gradually disappeared. Since exact echocardiographic imaging of vascular anomalies can be challenging in some patients, the occurrence of pulmonary artery sling in the individuals with distal 18q deletion is likely not so exceptional, but rather it may be missed during routine echocardiographic evaluation. Therefore, the definitive diagnosis should be made using computed tomography angiocardiography, which is preferred to magnetic resonance imaging due to better visualization of lung parenchyma and airways, higher spatial resolution, and faster scanning with lower requirement of sedation. To our knowledge, this is the first report of pulmonary artery sling in a patient with a distal 18q deletion.
Respiratory Physiology & Neurobiology, 2019
Respiratory sinus arrhythmia (RSA) is an index of cardiovagal regulation, emotional and cognitive... more Respiratory sinus arrhythmia (RSA) is an index of cardiovagal regulation, emotional and cognitive processing. RSA is quantified using heart rate variability (HRV) spectral analysis at respiratory-linked high-frequency band (HF-HRV) using Fast Fourier transformation (FFT) or autoregressive (AR) method, both requiring resampling of recordings-a potential source of error. We hypothesized that rarely used HRV time-frequency analysis with Lomb-Scargle periodogram (LSP) without resampling could be more sensitive to detect neurocardiac response to posture change than FFT and AR. Orthostasis (posture change from supine to standing) evoked significant decrease of HF-HRV well detectable by FFT, AR, and LSP. In contrast, during posture change from sitting to lying, significant increase of HF-HRV and peak HF was best detected using LSP. In regression analysis, the associations between RR-interval, HF-HRV, and peak HF were best detected when evaluated using LSP. Time-frequency HRV analysis with LSP could represent an important alternative to conventional FFT and AR methods for assessment of cardiovagal regulation indexed by RSA.
Scandinavian journal of clinical and laboratory investigation, 2017
Arterial stiffness is a marker of vascular damage. Although adiposity increases cardiovascular ri... more Arterial stiffness is a marker of vascular damage. Although adiposity increases cardiovascular risk, the relationship between paediatric overweight and arterial stiffness is unclear. The study aimed to evaluate the simultaneous effect of hypertension and overweight on arterial stiffness using cardio-ankle vascular index (CAVI) and related novel, theoretically blood pressure (BP)-independent, index CAVI. CAVI and CAVI were measured in 140 adolescent boys (16.0 ± 1.9 years) divided into age-matched groups: normal-weight normotensives, overweight normotensives, overweight white-coat hypertensives, and overweight essential hypertensives. Overweight normotensives had significantly lower CAVI and CAVI compared to normal-weight normotensives (4.81 ± 0.64 vs. 5.33 ± 0.66, p < .01; 7.10 ± 0.99 vs. 7.81 ± 1.00, p < .01, respectively). CAVI and CAVI in overweight essential hypertensives showed no significant difference compared to normal-weight normotensives and were significantly higher...
Indian Journal of Medical Research, 2016
Respiratory sinus arrhythmia (RSA) is accepted as a peripheral marker of cardiac-linked parasympa... more Respiratory sinus arrhythmia (RSA) is accepted as a peripheral marker of cardiac-linked parasympathetic regulation. According to polyvagal theory, the RSA is also considered as the index of emotion regulation. The neurovisceral integration model posits that parasympathetic modulation of the heart marked by RSA is related to complex nervous regulation associated with emotional and cognitive processing. From this perspective, high resting RSA amplitude associated with a greater withdrawal during stressors and subsequent recovery could represent a flexible and adaptive physiological response system to a challenge. Conversely, low resting RSA accompanied by an inadequate reactivity to stress might reflect maladaptive regulatory mechanisms. The RSA reactivity is different with various types of stressors: while the RSA decreases to cognitive tasks indicating a vagal withdrawal, the RSA magnitude increases to emotional challenge indicating an effective cognitive processing of emotional stimuli. The RSA reactivity to stress could have important implications for several mental disorders, e.g. depressive or anxiety disorder. It seems that the study of the RSA, as a non-invasive index of 'brain-heart' communication, could provide important information on the pathway linked to mental and physical health.
Uploads
Papers by Alexander Jurko